The Human Upgrade with Dave Asprey

Episode 1446 — "Why Doctors Can't Fix Women in 2026"

Guests: Dr. Sarah
Date: April 9, 2026

Overview

In this episode, host Dave Asprey and Dr. Sarah (InnerBalance.com) dive deep into the crisis and future of women's hormone therapy, exploring why standard medical practice fails women, what the true foundations of women's health are, and how innovative strategies—notably around hormone optimization—are key for both longevity and well-being. With candid banter and scientific rigor, Dave and Dr. Sarah challenge outdated ideas, dig into hormone delivery systems, debunk dietary dogma, discuss personal anecdotes, and provide a detailed roadmap for men and women seeking to reclaim their energy, libido, and health through hormone management.

Main Themes

• The crisis in women's hormone therapy and how doctors are failing women
• Why hormones are foundational to health, longevity, relationships, and energy
• Innovative (and overlooked) approaches to hormone delivery and optimization
• Dietary strategies: protein over fiber, pitfalls of plant-based dogma, and the oxalate issue
• The intersection of sex hormones, mood, mitochondria, and immunity
• The role of iodine and thyroid in hormone health
• Personalization: Why “normal” labs and one-size-fits-all treatments fail
• Parallel lessons for men’s hormone therapy

Key Discussion Points and Insights

1. Impact of Hormones on Relationships and Mood

• Hormone Imbalance Fuels Relationship Turmoil:
  • Dr. Sarah shares stories of women whose irritation with their partners resolved with hormone therapy.
    • “They couldn't stand him anymore... then they got on the hormones and they're like, he's fine. It wasn't him.” (Dr. Sarah, 00:03)
• Undiagnosed Hormone Issues Drive Divorces: - “What percent of divorces are caused by low hormones? It's a lot.” (Dave Asprey, 00:00; 52:01)

2. Double Standard in Hormone Treatment

• Men Receive More Robust Therapy:
  • "If your doctor won't give you testosterone... you're fired. And if you're a woman and your doctor says [no], get a better doctor. Your doctor works for you." (Dave Asprey, 05:55)
• Women Are Underserved and Products Are Outdated:
  • Only 30% of topical hormone products absorb; oral pills are largely metabolized in the liver, producing toxic metabolites and minimal hormonal benefit. (Dr. Sarah, 06:15)

3. Scientific Gaps and Outdated Standards

• Hormone Therapy for Women Is Stuck in the 1960s: - "Nobody has designed or innovated on women's hormone therapy since the 1960s. And those were made by men." (Dr. Sarah, 07:15)
• Men Have Better, More Direct Hormone Formulations: Women get mostly weak patches and poorly absorbed pills. (Dr. Sarah, 06:47)

4. Hormone Levels & Lab Testing Are Poorly Understood

• "Normal" Labs Don't Equal Well-being:
  • "Labs are not going to help because we have not established appropriate reference intervals... for women." (Dr. Sarah, 33:16)
  • Optimal therapy should target feeling good and functional outcomes, not arbitrary numbers. (47:48)
• Symptoms Come Before Diagnosis or Lab Abnormalities:
  • "If you have more than one thing going on, this is most likely hormonal—not mitochondrial." (Dr. Sarah, 31:53)

5. Diet, Fiber, Protein & Plant-based Myths

• Anti-Fiber, Pro-Protein for Women:
  • High fiber reduces estrogen, worsens constipation—what women need is estrogen, not fiber. (Dr. Sarah, 08:22-09:52)
    • "If you're taking handfuls of sawdust every day [fiber] and it absorbs the things your body needs... maybe it's the fiber." (Dave Asprey, 08:56)
• Carnivore/Low-Plant Diet Improves Symptoms:
  • "Are you carnivore? Yeah, 100%... I like fruit every now and then." (Dr. Sarah, 14:02)
• Phytoestrogens and Seeds Deemed Useless:
  • "Phytoestrogens... garbage... why when you can have the real thing?" (Dr. Sarah, 13:14)
• Oxalates’ Hidden Dangers:
  • Discussion of kidney stones, autoimmunity, and hormones impaired by high-oxalate diets (greens, nuts, chocolate, matcha). (69:03–73:12)
    • "Oxalates are plant protective compounds... razor-sharp calcium crystals that accumulate in your ovaries, brain, uterus, breasts..." (Dave Asprey, 69:15)

6. Importance of Method and Dose in Hormone Delivery

• Vaginal Delivery as Game Changer:
  • "The vaginal wall is porous, it goes right into the bloodstream... the uterus makes special metabolites... it's so important that people understand not only do the hormones matter, the formulations matter." (Dr. Sarah, 41:20)
• Downsides of Patches, Pills, Pellet Implants:
  • Patches and pills are usually too low dose and poorly absorbed; pellets can cause excessive testosterone in women. (Dr. Sarah, 38:24)
• Progesterone Converts to Testosterone in Women:
  • "Give her enough vaginal progesterone; she will convert and raise her testosterone to at least normal." (Dr. Sarah, 54:15; 54:27)
• Testosterone Cream for Women—Useful, With Caveats:
  • Can cause hair loss at higher/long-term doses. (Dr. Sarah, 55:36)

7. Personalized, Not Gendered, Hormone Targets

• Ratios Over Absolute Numbers:
  • "Women need 10 to 30 times more progesterone than testosterone or estrogen..." (Dr. Sarah, 20:00)
  • "Treat the symptoms, not the numbers." (Dave Asprey, 46:43)
• Men Need Estrogen, Women Need Testosterone:
  • “If men need estrogen and testosterone and some progesterone... and women need both as well, trying to dress one... in pink and the other... in kettlebells doesn't seem scientific.” (Dave Asprey, 19:24)

8. Relationship Between Hormones, Neurotransmitters, and Cognitive Function

• Hormones Drive Well-being, Not Just Sex:
  • "Hormones are messengers... at the foundation of health, wellness, and longevity." (Dr. Sarah, 10:09; 17:23)
  • Estrogen modulates dopamine, norepinephrine, and serotonin—crucial for libido, drive, and mood. (Dr. Sarah, 21:53)

9. The Gut, Immunity, and Autoimmunity

• Low Sex Hormones Cause Leaky Gut and Immune Disorders:
  • "Estrogen and progesterone make mucin, ensure the gut's tight junctions are closed..." (Dr. Sarah, 50:35)

10. Iodine, Thyroid, and Sex Hormone Synergy

• Massive Unaddressed Iodine Deficiency—Immediate Health Effects:
  • "Doctors tell women to stay away from the very things that will make them healthy, which is hormones and iodine." (Dr. Sarah, 58:11)
  • Breast and uterus have more iodine receptors than the thyroid—key to estrogen metabolism and cancer prevention. (Dr. Sarah, 59:12)
• How to Supplement Iodine:
  • "Treat fibrocystic breast disease with at least 2000 mcg/day; after resolution, maintenance is much lower." (Dr. Sarah, 62:47)

Notable Quotes and Memorable Moments

Hormone Crisis and Relationships

• “It wasn't him. It's actually a problem that we don't recognize enough. And then we treat men with Viagra and testosterone too. We're not treating women, and so we're setting their relationship up for turmoil.”
  — Dr. Sarah (00:30, 52:41)

• "If one partner goes on hormone replacement therapy, you have to put the other one on."
  — Dave Asprey (52:56)

Scientific Critique

• "Nobody has designed or innovated on women's hormone therapy since the 1960s. And those were made by men... very fear based and it's not based on any science."
  — Dr. Sarah (07:15)

• "Your doctor works for you. That's how it works."
  — Dave Asprey (05:55)

Against “Fiber as Panacea”

• "Women need more nourishment than men, on average... if you're taking handfuls of sawdust every day [fiber]... maybe it's the fiber."
  — Dave Asprey (08:56)

• "I don't know why anybody wants to go to bathroom. Going to bathrooms is like a full-time job for them, like fiber."
  — Dr. Sarah (09:29)

Diet, Plants, and Hormones

• "Are you carnivore? Yeah, 100%. I like fruit. Like, I'll eat fruit every now and then."
  — Dr. Sarah (14:02)

• “Phytoestrogens... that's garbage. I mean, why when you can have the real thing?”
  — Dr. Sarah (13:14)

Lab Testing and Personalization

• "Labs are not going to help because we have not established appropriate reference intervals for labs for women."
  — Dr. Sarah (33:16)

• "Treat the symptoms, not the numbers."
  — Dave Asprey (46:43)

On the Sexual Symptoms of Hormone Optimization

• “When we put men on testosterone, an erection is like an obvious thing... Women have it too. It's called a morning bean."
  — Dave Asprey (25:47–26:00)

Iodine and Thyroid

• "Doctors will tell women to stay away from the very things that will make them healthy, which is hormones and iodine."
  — Dr. Sarah (58:11)

• "So I think it’s bullshit [that iodine is dangerous for Hashimoto’s]."
  — Dr. Sarah (59:03)

Timestamps for Key Segments

• [00:00]– Hormones’ impact on relationships
• [04:49]– Why men get more hormone therapy than women—industry failings
• [06:15]– Poor absorption, outdated products, and the engineering problem for women
• [08:22]– The anti-fiber, pro-protein discussion
• [10:19]– How to define “normal” after menopause; why periods are the wrong metric
• [17:23]– What do sex hormones do for women’s brains?
• [20:00]– Ratio of hormones for women's optimal function
• [25:37]– Recognizing physical signs of libido in men and women
• [31:53]– If you have multiple symptoms, think hormones first
• [33:16]– Labs and the lack of reference ranges for women
• [41:20]– Vaginal delivery of hormones and its systemic effects
• [46:43]– Treat symptoms, not the numbers
• [50:35]– Sex hormones' role in gut health and leaky gut
• [58:11]– The role of iodine and why most doctors have it wrong
• [69:03]– Oxalates, diet fads, and the risks for kidney/adrenal health
• [75:27]– Dr. Sarah's practice and closing remarks

Practical Takeaways

For Women

• Find a doctor who understands modern, comprehensive hormone therapy.
• Demand better delivery systems (vaginal preferred for progesterone and estrogen) over standard patches/pills.
• Reconsider excess plant foods (especially fiber and high-oxalate foods) if you’re dealing with hormonal or gut troubles.
• Test and address iodine deficiency, especially if you have fibrocystic breast disease.
• Treat symptoms and well-being as the real target, not just “normal” labs.
• Don’t be afraid to pursue hormone optimization before chasing functional medicine fads or drastic dietary changes.

For Men

• You may benefit from low-dose progesterone (often overlooked) to optimize testosterone and feel more balanced.
• Thyroid health and iodine matter for your hormones, too.
• Don’t accept “good enough” hormone ranges—aim for what feels optimal to you.

Tone and Style

Lively, direct, slightly irreverent, but deeply practical and empathetic. Dave and Dr. Sarah blend personal anecdotes, clinical insights, and blunt myth-busting with actionable steps for listeners.

This summary covers all key scientific, practical, and conversational highlights of the episode. For detailed protocols and more, visit Dr. Sarah at innerbalance.com or attend Dave’s next biohacking event for deeper dives into hormone and mitochondrial optimization.